超声心动图评价肺栓塞患者右心室形态与功能的价值

Evaluation of Right Ventricular Morphology and Function in Pulmonary Embolism with Echocardiography

目的探讨超声心动图评价肺栓塞患者右心室形态和功能变化的临床价值。方法以健康体检者30例为对照组;肺栓塞患者28例分为高危组8例,中危组12例,低危组8例。测量右心常规超声指标:右心房横径(RA)、右心室横径(RV)、肺动脉主干内径(MPA)及肺动脉收缩压(SPAP);运用组织多普勒成像(TDI)技术测算右心室Tei指数。结果肺栓塞高危组右心较对照组明显增大(P<0.05);中危组有轻度肺动脉高压(P>0.05);低危组患者无右心增大和肺动脉高压;高危组SPAP明显高于中危组,肺动脉高压征象较中危组明显(P<0.05);高危组右心室射血时间(ET)较其余3组明显缩短(P<0.05),等容收缩时间与等容舒张时间之和(ICT+IRT)明显延长(P<0.05),Tei指数明显增高(P<0.05);中危组右心室ET较低危组、对照组明显缩短(P<0.05),ICT+IRT、Tei指数均较低危组、对照组高(P<0.05);低危组右心室ET、ICT+IRT、Tei指数与对照组相比,差异无统计学意义(P>0.05)。结论超声心动图可评价肺栓塞患者右心室形态与功能的变化,右心室Tei指数可以较敏感反映肺栓塞患者右心室功能变化,是评价其右心室综合功能的较好指标。

Objective To investigate the clinical value of echocardiography in evaluating right ventricular morphology and function in patients with pulmonary embolism（PE）. Methods Thirty healthy controls and 28 patients with pulmonary embolism were studied and the patients were divided into 3 subgroups such as high-risk （n = 8）, moderate-risk （n = 12）,low-risk（n =8） groups. Traditional ultrasonic parameters of right heart, such as diameters of right artery（RA）, right ventricle（RV） and main pulmonary artery（MPA） were measured,as well as systolic pulmonary artery pressure （SPAP）. Tissue Doppler imaging（TDI） was used to calculate Tei index of fight ventricle. Results Right heart was enlarged significantly in high-risk group compared with the controls （P 〈 0.05 ） ;moderate-risk group showed mild pulmonary hypertension（P 〉 0.05 ） ; no enlarged right heart and pulmonary hypertension could be found in low-risk group （P 〈 0.05 ） ; SPAP was significantly higher in high-risk group than that in moderate-risk group, and more significant signs of pulmonary hypertension were showed in moderate-risk group （ P 〈 0.05 ） ; abnormal time parameters such as shorter right ventricular ejection time（ET） ,longer isovolumetric contraction and isovolumetric relaxation time（ICT ＋ IRT）, and increased Tei index were showed in high-risk group compared with those in the other three groups （P 〈 0.05 ） ; ET of right ventricle was significantly shorter（ P 〈 0.05 ）, and ICT ＋ IRT and Tei index were higher in moderate-risk group than those in low-risk group or control group （ P 〈 0.05 ） ; there was no significant difference in ET, ICT ＋ IRT, Tel index of right ventricle between low-risk group and control group （ P 〉 0.05 ）. Conclusion Variations of right ventricular morphology and function in patients with pulmonary embolism can be evaluated by echocardiography. Tei index is a sensitive indicator for detecting the changes of right ventricular function and evaluating right ventricular global fimction.